The American College of Physicians and the American Pain Society have issued a Joint Clinical Practice Guideline. The key recommendation: "For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits--for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation."

The research supporting this recommendation: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline (Cho and Huffman, Annals of Internal Medicine, 2007) found "Good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (longer than 4 weeks duration) low back pain."

Also cited was efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence sythesis (Spine Journal May-June 2004.)

"For acute low back pain (less than 4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat and spinal manipulation."

Please contact our office if you would like further evaluation on your condition.